This notice describes how medical information about you may be used and disclosed, and how you can gain access to this Information. Please review it carefully.

 

SERENITY WELLNESS INSTITUTE

Protected Health Information (PHI) about you is maintained as a written and/or electronic record of your contacts or visits for healthcare services with our practice. Specifically, PHI is information about you, including demographic information (i.e., name, address, phone number, etc.), that may identify you and that relates to your past, present, or future physical or mental health condition and related healthcare services.

 

Our practice is required to follow specific rules for maintaining the confidentiality of your PHI, using your information, and disclosing or sharing this information with other healthcare professionals involved in your care and treatment. This Notice describes your rights to access and control your PHI. It also explains how we comply with applicable rules, and how we use and disclose your PHI to provide your treatment, obtain payment for the services you receive, manage our healthcare operations, and for other purposes permitted or required by law.

 

Your Rights Under the Privacy Rule
The following is a statement of your rights, under the Privacy Rule, with respect to your PHI. Please feel free to discuss any questions with our staff.

You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices.
We are required to follow the terms of this Notice. We reserve the right to change the terms of our Notice at any time. Upon your request, we will provide you with a revised Notice of Privacy Practices if you call our office and request that a revised copy be sent to you by mail, or if you ask for one at the time of your next appointment. The Notice will also be posted in a conspicuous location within the practice and, if applicable, on our website.

You have the right to authorize other uses and disclosures
This means you have the right to authorize any use or disclosure of PHI that is not specified within this Notice. For example, we would need your written authorization to use or disclose your PHI for marketing purposes, for most uses or disclosures of psychotherapy notes, or if we intended to sell your PHI. You may revoke an authorization at any time, in writing, except to the extent that your healthcare provider or our practice has already taken action in reliance on the use or disclosure indicated in the authorization.

You have the right to request an alternative means of confidential communication
This means you have the right to ask us to contact you about medical matters using an alternative method (e.g., email, telephone) and to a destination (e.g., cell phone number, alternate address, etc.) designated by you. You must inform us in writing, using a form provided by our practice, of how you wish to be contacted if different from the address or phone number we have on file. We will accommodate all reasonable requests.

 

You have the right to inspect and copy your PHI
This means you may inspect and obtain a copy of your complete health record. If your health record is maintained electronically, you also have the right to request a copy in electronic format. We have the right to charge a reasonable fee for paper or electronic copies, as established by professional, state, or federal guidelines.

You have the right to request a restriction of your PHI
This means you may ask us, in writing, not to use or disclose any part of your Protected Health Information for purposes of treatment, payment, or healthcare operations. If we agree to the requested restriction, we will abide by it, except in emergency circumstances when the information is needed for your treatment. In certain cases, we may deny your request for a restriction. You also have the right to request, in writing, that we restrict communication to your health plan regarding a specific treatment or service that you, or someone on your behalf, has paid for in full out-of-pocket. We are not permitted to deny this specific type of requested restriction.

You have the right to request an amendment to your Protected Health Information (PHI)
This means you may request an amendment to your PHI for as long as we maintain this information. In certain cases, we may deny your request.

You have the right to request a disclosure accountability
This means you may request a listing of disclosures we have made of your PHI to entities or persons outside of our office.

You have the right to receive a privacy breach notice
You have the right to receive written notification if the practice discovers a breach of your unsecured PHI and determines, through a risk assessment, that notification is required.

If you have questions regarding your privacy rights, please feel free to contact our Privacy Manager. Contact information is provided on the following page under Privacy Complaints.

How We May Use or Disclose Protected Health Information

The following are examples of uses and disclosures of your Protected Health Information (PHI) that we are permitted to make. These examples are not exhaustive but are intended to describe possible types of uses and disclosures.

Treatment
We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. This includes the coordination or management of your healthcare with a third party involved in your care and treatment. For example, we may disclose your PHI, as necessary, to a pharmacy to fill your prescriptions. We may also disclose PHI to other healthcare providers who may be involved in your care and treatment.

Special Notices
We may use or disclose your PHI, as necessary, to contact you to remind you of your appointments. We may contact you by phone or other means to provide results from exams or tests and to provide information about treatment alternatives regarding your care. We may also contact you to provide information about health-related benefits and services offered by our office, for fundraising activities, or, in the context of a group health plan, to disclose information to the plan sponsor. You will have the right to opt out of such special notices, and each such notice will include instructions for opting out.

Payment
Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities your health insurance plan may undertake before it approves or pays for the services we recommend, such as determining eligibility or coverage for insurance benefits.

Healthcare Operations
We may use or disclose, as needed, your PHI to support the business activities of our practice. This includes, but is not limited to, business planning and development, quality assessment and improvement, medical review, legal services, auditing functions, and patient safety activities.

Health Information Organization
The practice may elect to use a health information organization, or a similar entity, to facilitate the secure electronic exchange of information for purposes of treatment, payment, or healthcare operations.

To Others Involved in Your Healthcare
Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, PHI that directly relates to that person’s involvement in your healthcare. If you are unable to agree or object, we may disclose information as necessary if we determine, in our professional judgment, that it is in your best interest. We may also use or disclose PHI to notify, or assist in notifying, a family member, personal representative, or any other person responsible for your care, of your general condition or death. If you are not present or able to agree or object, your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In such cases, only the minimum necessary PHI will be disclosed.

Other Permitted and Required Uses and Disclosures
We are permitted to use or disclose your PHI without your written authorization for the following purposes: as required by law; for public health activities; for health oversight activities; in cases of abuse or neglect; to comply with Food and Drug Administration requirements; for research purposes; for legal proceedings; for law enforcement purposes; to coroners, medical examiners, and funeral directors; for organ donation; in cases of criminal activity; for military activities; for national security; for worker’s compensation; when you are an inmate in a correctional facility; and if requested by the Department of Health and Human Services to investigate or determine our compliance with the Privacy Rule.

Privacy Complaints

You have the right to file a complaint with us, or directly with the Secretary of the Department of Health and Human Services, if you believe your privacy rights have been violated. You may file a complaint with us by contacting our Privacy Manager at the address listed on the following page under Privacy Complaints.

We will not retaliate against you for filing a complaint.